Delusions

Presenter : Dr Srinivas
Chair person : Dr.V.V.SESHAMMA
 OUTLINE
• ETYMOLOGY
• DEFINITION
• CHARACTERISTICS OF DELUSIONS
• PATHOLOGY
• THE ORIGINS OF DELUSIONS
• DEVELOPMENT OF DELUSIONS
• VECTORS
• TYPES OF DELUSIONS
• CONTENT OF DELUSIONS
 ETYMOLOGY
 English word delude comes from Latin—
playing or mocking, defrauding or cheating.

• German equivalent wahn is a whim ,false

opinion or fancy
 DEFINITION

Hamilton (1978) defined delusion as ‘a false unshakeable

belief which arises from internal morbid processes. It is
easily recognizable when it is out of keeping with the
person’s educational and cultural background

Spitzer’s (1994): delusional statements are

expressed with conviction and certainty and not
subject to discussion and inquiry.
• Berrios(1996) : delusions are empty speech
acts which assert themselves as beliefs,he
makes the point that the content of delusions is
incidental to the fact of the phenomenon being
a delusion
• Stoddart’s(1908) : A judgement which cannot
be accepted by people of the same class,
education, race and period of life as the person
who experiences it’
 CHARACTERISTICS OF DELUSION
JASPERS(1959):Delusions are manisfest in judgements
and arise in the process of thinking and judging
For Jaspers characteristics of delusions
1. they are false judgements;

2. they are held with extraordinary conviction and

incomparable subjective certainity;

3. they are impervious to other experiences and to

compelling counterarguement &

4. their content is impossible.

 PATHOLOGY
TO ELUCIDATE THE PRECISE FORMS OF PATHOLOGY UNDERLYING
DELUSIONS HAVE TENDED TO FOCUS ON

A) Developing models of cognitive underpinnings

of delusional beliefs.

B) Using novel neuroimaging techniques to

identify brain areas or process involved in
developing & maintaining delusions
COGNITIVE PERSPECTIVE

Huq et al (1988) : delusions tend to make

guesses based on less evidence than individuals
with psychiatric illness who don’t have delusions
Garety et al(1991):changes their mind more
rapidly than without delusions
Bental(1990) :devised a useful heuristic model
of perceptual & cognitive process involved in
developing & maintaining beliefs & has
expanded this model to explain delusion
COGNITIVE PERSPECTIVE(contn)
• Gilleen &David (2005):provide a valuable review of
cognitive neuropsychiatry of delusion, Focusing on
reasoning bias
Attentional & attributional biases
Relevance of emotion & theory of mind
NEUROIMAGING PERSPECTIVE
a) SZESZKO (1999): possible neurodevelopment
aspect to etiology of delusion.
b) BLACKWOOD(2000):anomalous connectivity &
activity in brain regions-cause delusion
c) PRASAD(2004)-entorhinal cortex pathology-
positive symptoms especially delusions
d) BLACKWOOD ,2004- association between
Abnormalities of cingulate gyrus activation &
PERSECUTORY DELUSION.
THE ORIGINS OF DELUSIONS
Factors involved in the germination of delusions
Brockington(1991)
Disorder of brain functioning
Background influence of temperament and
personality
Maintenance of self-esteem
The role of affect
As a response to perceptual disturbance
As a response to depersonalization
Associated with cognitive overload
THE ORIGINS OF DELUSIONS
CONARD PROPOSED FIVE STAGES IN THE DEVELOPMENT OF
DELUSIONAL PSYCHOSIS

Trema: delusional mood representing a total change in

perception of the world

Apophany: A search for,and the finding of a new meaning

for the psychological events

Anastrophy: heightening of the psychosis

Consolidation: forming of a new world or psychological

set based on new meanings

Residuum: eventual autistic state

 CONVICTION- DEVIANT
the degree to which
PRESSURE- the the patient is BEHAVIOUR
degree to which the convinced of the
reality of delusional
RESULTING
patient is preoccupied beliefs. FROM
& concerned with
expressed delusional
DELUSIONS-
beliefs. patients sometimes,
but not always, act
AFFECTIVE on their delusions.
RESPONSE–
the degree to
which patient’s
emotions are
involved with such EXTENSION-
DISORGANISATION- the degree to the
beliefs.
the degree to which delusional belief
delusional beliefs are involves area of
patient life.
internally consistent, BIZARRENESS-
logical & systematized the degree to which
the delusional beliefs
depart from
culturally VECTORS OF DELUSIONAL
determined
consensual reality.
SEVERITY by KENDLER (1983)
TRUE DELUSION (VS) DELUSION LIKE IDEAS

TRUE DELUSION LIKE

DELUSIONS/DELUSI IDEAS
ONS PROPER Secondary delusions
Result of primary
delusional experience Seen to emerge
cannot be so understandable from the
explained ,they are patient’s internal
psychologically &external environment
irreducible
 OVERVALUED IDEAS
• Can occur in both healthy & mentally ill.
• This is a thought that, because of the associated
feeling tone, takes precedence over all other ideas
and maintains this precedence permanently or for a
long period of time.
• McKenna(1984) It refers to a solitary, abnormal
belief that is neither delusional nor obsessional in
nature, but which is preoccupying to the extent of
dominating sufferer’s life.
DISORDERS WITH OVERVALUED IDEAS
• Paranoid state: Querulous (or) litigious type.
• Morbid jealousy.
• Hypochondriasis.
• Dysmorphophobia.
• Parasitophobia (Ekbom’s syndrome).
• Anorexia nervosa.
• Transsexualism.
Abnormality of personality is usually present
with overvalued ideas in all these conditions
 PRIMARY DELUSIONS
• The essence of the primary delusional experience
(also termed apophany) is that a new meaning
arises in connection with some other psychological
event
• SCHNEIDER –3 forms of Primary delusion
experience
DELUSIONAL MOOD/DELUSIONAL ATMOSPHERE
DELUSIONAL PERCEPTION
SUDDEN DELUSIONAL IDEA/Autochthonous delusion
/delusional intuition
DELUSIONAL MOOD

• In the delusional mood the patient has the

\
knowledge that there is something going on around
him that concerns him, but he does not know what
it is.

• Delusional mood is obvious when sudden delusional

idea & delusional perception occur
 DELUSIONAL PERCEPTION
• Schneider (1949) :Abnormal significance attached
to a real percept without any cause that is
understandable in rational or emotional terms

• Delusional perception must not be confused with

delusional misinterpretation
 DELUSIONAL PERCEPTION cont.
Schneider emphasized ‘two memberedness’,
• 1st link is a link from the perceived object to the
subject’s perception of this object
• 2nd link to the new significance of this perception.

• E.g. If the patient says that they are of royal descent

because they remember that the spoon they used as
a child had a crown on it, this is really a delusional
perception because there is the memory and also the
delusional significance, i.e. the ‘two memberedness’.
 SUDDEN DELUSIONAL IDEA
• Delusion appears fully formed in the patient’s mind.
This is sometimes known as an autochthonous
delusion.
• In patients with depressive disorders or severe
personality disorders sudden ideas or over valued ideas
can occur
• e.g. patient says that they are of royal descent because
when they were taken to a military parade as a small
child the king saluted them, then this is a sudden
delusional idea because the delusion is contained
within the memory and there is no ‘two
memberedness’.
SECONDARY DELUSIONS & SYSTEMATIZAION

• Arising from some other morbid experience.

• Delusions can be Secondary to depressive

moods, hallucinations and psychogenic or
stress reactions can give rise to psychotic
states with delusions.
SYSTEMATIZED NON SYSTEMATIZED
DELUSIONS DELUSIONS

• Restricted or • Extend into many areas of

circumscribed to well life , new people and
delineated areas situations are constantly
incorporated to further
support the presence of the
• Associated with clear delusion
sensorium and absence
of hallucinations • Associated with mental
confusion and hallucinations
Classification of delusion on basis of content
o DELUSION OF PERSECUTION
o DELUSION OF JEALOUSY
o DELUSION OF LOVE
o GRANDIOSE DELUSION
o DELUSION OF ILL HEALTH
o DELUSION OF GUILT
o NIHILISTIC DELUSION
o DELUSION OF POVERTY
o DELUSION MISIDENTIFICATION
o DELUSION OF INFESTATION
o COMMUNICATED INSANITY
 DELUSION OF PERSECUTION
• when someone believes others are out to harm
them despite evidence to the contrary
May occur in context of Primary delusional
experience in acute schizophrenia, auditory
hallucination, bodily hallucination, experience of
passivity.
Conditions associated with persecutory delusions
Bipolar disorder
Depression
Drug abuse
Paranoid personality disorder 
Schizophrenia:persecutory delusions are
considered positive symptoms
 Delusion of persecution can take many forms

•DELUSION OF REFERENCE: Patient feel that strangers are talking about

him/her ,slandering /spying on him.

•DELUSION BASED ON SOMATIC HALLUCINATION: Patient believe they/their loved ones are
about to be killed or that their family members are tortured.

•Delusion of guilt or sin (or delusion of self-accusation):A person may, for example, believe
that he or she has committed some horrible crime and should be punished severely.

•DELUSION OF POISIONING: patient believe that the spouse is poisoning them. It is based on
hallucinations of smell & taste.

•DELUSION OF INFLUENCE : Logical result of experience of passivity-diagnostic of

schizophrenia.
Passivity explained as a result of –hypnotism, demonical possession, witchcraft, radio
waves, atomic rays or television.
 DELUSIONS OF INFIDELITY
•  Othello syndrome : Also called morbid jealousy,
this is a delusional belief that one’s spouse/partner
is being unfaithful.
• It effects males and less often females
• The syndrome may appear by itself or in the course of
paranoid schizophrenia , alcoholism, or cocaine addiction
• syndrome can result in disruption of a marriage, homicide
and suicide
 DELUSIONS OF LOVE
De Clerambault’s syndrome / Erotomania / fantasy lover
syndrome
• The affected person strongly believes that another
individual is in love with him or her despite clear
evidence against it.
• The object of the person's delusions is often a
celebrity or a person of a higher social status
• it affects women more
often than men.
 GRANDIOSE DELUSION

• person with grandiose delusion has an over-inflated

sense of worth, power, knowledge, or identity. The
person might believe he or she has a great talent or
has made an important discovery
• common with bipolar disorder
and schizophrenia.
 DELUSIONS OF ILL HEALTH

• Individuals believe they have a serious disease,

cancer, tuberculosis ,AIDS, and so on.

• Characteristic feature of depressive illnesses, but

also in schizophrenia .

• They may involve the patient’s spouse and children

take the form of primary and secondary delusions
of incurable insanity.
 DELUSIONS OF GUILT
 This is a false feeling of remorse
or guilt of delusional intensity. A person believe
that he or she has committed some horrible crime
and should be punished severely

• Seen in depression-mild, severe & very severe

• In very severe :May even appear to take on a

grandiose character and the patient may assert that
they are the most evil person in the world.
 NIHILISTIC DELUSIONS
• The patient denies the existence of their body,
their mind ,their loved ones and the world around
them.

• They believe that they are dead, the world has

stopped or every one else is dead.

• Seen in- in severe depression ,schizophrenia and

states of delirium
 DELUSIONS OF POVERTY

•  False belief about having lost one's livelihood

and that one is poor or that poverty is inevitable 
• The patient is convinced that they are
impoverished and believe that destitution is
facing them and their family

• Seen- typically in DEPRESSION

 DELUSIONAL MISIDENTIFICATION
CAPGRAS
FREGOLI’S SYNDROME
SYNDROME: :

• Person belives that a • It’s the delusional

person usually closely misidentification of an
unfamiliar person as a familiar
related to him, has been one even though there is no
replaced by an exact
physical resemblance.
double.
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DELUSIONAL MISIDENTIFICATION
• SYNDROME OF INTER METAMORPHOSIS:
The delusional belief that others undergo radical
changes in physical and psychological identity,
culminating in a different person altogether.

• SYNDROME OF SUBJECTIVE DOUBLES:

The delusional belief in the existence of physical
duplicates of the self, and these duplicates are usually
thought to have different psychological identities.
 DELUSIONAL INFESTAION
• Patient believe that they had a spider in their hair,worms and lice
beneath the skin or infestation with various insects

• Explained by HOPKINSON (1970) AND REILLY(1988)

• Occur in patient >50yrs
• Seen in:
• Affective psychosis
• Paranoid schizophrenia
• Monosymptomatic hypochondriacal condition
• Organic brain syndrome
• Alcohol abuse & cocaine abuse
• Senile dementia
 STAGES OF INFESTATION

o 1st- Abnormal cutaneous sensation

o 2nd- Development of illusion
3rd- Fully formed delusion of infestation

• EKBOM’S SYNDROME (1938): Patient believes

that he is infestated with small but
macroscopic organisms.
 COMMUNICATED INSANITY
• LASEGUE & FALRET(1877)- described ‘la folie a deux’
• Delusion is transfered from psychotic person to one or
more others with they have been in close association ,so
that the recipient shares the false belief
• PSYCHOSIS OF ASSOCIATION:situation in which partners
accept ,support and share each other’s beliefs

• GRAlNICK(1942) subdivided
it into 4 types:
• Folie imposee- delusion of mentally ill – not previous
mentally ill – but has social psychological disadvantage –
separation of pair- remission of symptom in associates.
 COMMUNICATED INSANITY cont.

• FOLIE COMMUNIQUEE: Normal person suffer- contagion of

his idea – after resisting them for long time – once acquires
these false belief – maintain them despite of separation.

• FOLIE INDUITE: Person already psychotic add – delusion of

closely associated person to his own.

• FOLIE SIMULTANEE: Two or more people become

psychotic share same delusional system simultaneously -
principal is always psychotic & associate may be or may
not be psychotic
 REALITY OF DELUSIONS
 Not all individual act on their delusional belief until it
become chronic
 Severe delusion of guilt with depression-surrender to police
 Delusion of infidelity-violence/homicide

 Delusions are a key clinical manifestation of psychosis and

have particular significance for the diagnosis of
schizophrenia. Although common in several psychiatric
conditions, they also occur in a diverse range of other
disorders (including brain injury, intoxication and somatic
illness).
 REFERENCES
• FISH’S clinical psychopathology.
• SIMS’ SYMPTOMS IN THE MIND
Text book of Descriptive Psychopathology
•

Thank you